22 Year-old Female, my Rhinoplasty Experience! - Beverly Hills, CA

Hi! I had been using RealSelf to explore...

15 Feb 2014

5 days post

Hi! I had been using RealSelf to explore rhinoplasty as an option for myself, and I decided to make and account to share my experience in return. I'm still learning how to post, so this might get edited.

I'll start with my background. I am a 22 year-old girl living in Los Angeles, California. Ever since middle school I had been unhappy with my nose. I am half Armenian and had the typical large Armenian nose. I disliked its prominence, its width, the little side bumps on my bridge, the large tip, and the drooping tip that additionally depressed when I smiled. It felt too big for my face, and I wanted to feel more feminine and less goofy. I was never bullied, but people have made disheartening comments through my life and called me names, and I developed a nagging anxiety about my nose that affected my self esteem and general comfort.

I thought about rhinoplasty for years, but timing, cost, fear, insecurity, and my young age held me back. Finally after my college graduation, the period between university and employment seemed like the ideal time to pursue it. After a lot of online research (and playing on Photoshop!), I came out to my mom and my boyfriend of 4 years about wanting to explore this. More than anything else they were surprised, because I hadn't ever openly expressed insecurity. But they both understood and were supportive which was awesome. I have some money saved up, but am also utilizing a payment plan and possibly a loan from my parents until I start working full-time. It's a big hit, but I decided that relieving myself of this self-consciousness and anxiety for possibly another 70 years was worth it!

I'll post again separately about my consultations and prep!

My pre-op consultations

16 Feb 2014

6 days post

I'll write this next update about my pre-op consultations. I used RealSelf as my primary tool for finding a surgeon. After hours of browsing, I scheduled consultations with two doctors: Richard Fleming and Robert Kotler, both in Beverly Hills, California.

Richard Fleming stood out to me because he was a Facial Plastic Surgeon, had decades of experience, great reviews, and had the most comments about rhinoplasty on RealSelf. I easily scheduled a waived-fee consultation with him for the next week. I started off slightly unhappy with his office. They kept my mom and I waiting for over an hour before we saw him, and their office seemed kind of dated with creaky antique furniture and unsanitary cloth towels in the examination room. However, meeting with Dr. Fleming was great. He heard all my needs, was friendly and confident, and very thoroughly pointed out on my face each thing he would tackle and specifically how. He used pointers and drew diagrams to explain the anatomy of my nose and the surgical techniques he would use, which I loved. I scheduled a follow-up appointment with him where he would draw on my blown-up photographs. My mom and I both felt like we would be comfortable having him perform the surgery.

Robert Kotler stood out to me because he was a Facial Plastic Surgeon, had decades of experience, a ton of amazing reviews specific to rhinoplasty, was a rhinoplasty specialist, and had before/after photos that looked customized to each face and natural. I easily scheduled an appointment with his nice staff for a $200 consultation fee. His office was more contemporary, and after having photos taken, I worked with their professional predictive imaging technician to create a desired result together. She knows Dr. Kotler's work well and promised to only create an image that he could produce through surgery. We then met Dr. Kotler, who gave his positive opinion of the images, heard my desires for surgery, and discussed the procedure further.

It was here that I was thrown off guard. Kotler wanted to do a closed surgery, Fleming wanted it open. Kotler didn't want to fix my slightly deviated septum (no breathing trouble), Fleming wanted to fix it just in case. Kotler wanted to release the muscle that pulled my nose down with smiling, Fleming said my nose was unaffected by that muscle. Kotler wanted to keep it simple, Fleming wanted to transplant cartilage from my septum into my nostrils to better support them. Kotler loved to utilize predictive imaging, Fleming thought it gave patients unrealistic expectations and was a poor choice. Both of these surgeons have decades of facial plastic surgery experience and wonderful reviews, but they contradicted each other on very fundamental things. Perhaps there just isn't one "right" answer, but I still didn't know who to follow.

I was feeling confused and lost after that consultation and didn't know what to trust. I turned back to RealSelf and the surgeons' websites, and after a lot of thought and going over my resources again, I chose Dr. Kotler. He was the rhinoplasty specialist, worked with more ethnic cases, seemed to keep up with advancements in the field rather than stay old-school, his reviews on RealSelf were very specific to rhinoplasty, and his before/after photos looked more like noses I would want for myself. I do think Dr. Fleming could have given me great results too, but I had to make a choice and that's what I decided.

The one thing I still wanted from Dr. Kotler was a more thorough, very specific detailing of exactly how he would tackle each of my issues through surgery. Rather than just approving of the predictive imaging and giving me a basic outline, I wanted to hear very specifically what he would do. I scheduled a second consultation that went very well, and I put down my deposit for my surgery with him only a few weeks away! Attached are my predictive images from my first consultation with Dr. Kotler and his staff.

Pre-op feelings and prep

17 Feb 2014

7 days post

I'll write this post covering anything between my second consultation with Dr. Kotler and my surgery. After my consultations and scheduling, I was mostly excited! It just felt crazy that after years of never mentioning that I wanted to pursue this, it was actually going to happen. Most of my anxiety lay in two places: telling friends and emotions through recovery.

Coming out to my family and boyfriend was scary enough, and now I had to think about if/how to tell other people in my life. It makes me feel so awkward and vulnerable to bring it up! I ended up telling a few friends when I was asked about upcoming plans. Mostly everyone has just been surprised, happy for me, and excited to see my results! If you're worried about telling people in your life, be comforted that at least for me, it's been getting easier and easier with every person I tell.

I was also nervous about my anxiety during recovery. I suffer from anxiety and panic attacks, and I worried that being patient through pain and grisly early results would be tough for me. I've read that people are often unhappy with their immediate results, looking too swollen or piggish, and feel regret. I knew to expect these feelings and that I can only judge my results after weeks if not months of healing, but it will be hard to not be shaken by them.

Since there were a few weeks until my surgery, the thought of it kind of fell to the background. As I started making plans for recovery time and going through the pre-op instructions, it felt like I was making plans for somebody else. It only hit me the day before surgery that this was actually happening, and I got pretty scared. I talked about it with my family and just reassured and distracted myself. I knew it was just anxiety rather than reconsideration, so I just kept reminding myself why I was doing this and focused on moving forward.

Day 1: Surgery

18 Feb 2014

8 days post

I woke up early and drove out to Beverly Hills with my mom and boyfriend. I was less nervous than the night before and was mostly focused on just getting there and doing this. We had little wait, and they took me in to get changed into my gown. Dr. Kotler greeted me and cheerfully went over things briefly. I got in bed and took a Valium to dissolve under my tongue and sat with my mom for a while just talking. My mom left so my boyfriend could have a turn, and he just sat by my bed and we talked. At first I didn't feel any effect of the Valium, but maybe after 30 min I went from engaged conversation with my boyfriend to more distant and not as willing to talk. Mellow I guess. Then I said goodbye and they took me to the operating room. The doctors started their prep and the anesthesiologist prepped my arm for the IV. I get super nervous about medical things and warned them all prior about my anxiety, and I started getting panicky then. The anesthesiologist was cool as a cucumber and asked me question after question about my life's background and I rattled off lengthy answers to distract myself.

And then... I woke up! I was so confused! Normally on TV they say "Count back from 10" and let you know when you're going under, but I just went from talking to the anesthesiologist as he swabbed my arm to waking up in the recovery room. Probably for the best! I could breathe through the Kotler Airway (tubes they leave in your nose with the packing so you can breathe) and my lip and most of my nose was numb. At some point my mom, boyfriend, a nurse, and Dr. K were all with me, and apparently I just kept repeating over and over how crazy it was that I didn't even know when I went under. I didn't feel pain yet and was loopy and groggy, and apparently I told Dr. K that he was like Christian from the show NipTuck, except he didn't fuck his patients. Hahaha whoops! The nurse helped me get my clothes back on and they went over my recovery instructions again. Even though I still felt out of it, I was wheeled out to the parking lot to be driven home.

The drive home was... chaos, lol. Pro tip, if you can have two people instead of one accompany you at the hospital, do that! While my mom was driving, my boyfriend was in back changing my gauze every few minutes because I was bleeding like crazy. The numbness was wearing off and pain was kicking in big time, and I had taken pain meds asap along with icing my face. But probably the biggest thing... I had to pee SO BADLY. And I had just gone like 30 min earlier. I'm guessing the IV fluids were to blame. We were on the freeway and I was seriously going to wet myself so I just laid a trash bag down on the car floor and sloppily pissed into a juice bottle. I know how to keep it classy!

Getting home felt like a miracle and I posted up on the couch and basically dozed. Honestly, the anesthesia and/or Valium and Codeine really affected my memory for a couple days, but I'll recall what I can. I felt exhausted and mostly just laid there eating small things and focusing on breathing. I was still bleeding to a point the instructions deemed "excessive" and worthy of calling my doctor, but just as we were about to call in, it subsided. The pain was worse than I predicted. I was taking the max pain med dosage as frequently as was allowed, and it still felt like someone was using like the back of a hammer to lean down on my upper lip. The Kotler Airway tubes helped with breathing and I'm glad I had them, but they got clogged a lot and were miserable to clean. I just kept choking on the water used to flush them. [At the next consultation we learned that apparently we were doing it somewhat wrong though.]

That night I got basically no sleep. I'm on medication that gives me major dry mouth, and when my Airway got clogged I could only breathe through my mouth and it got unbearably dried out. I also have acid reflux and for some reason it was so bad during these first few days. I would awaken several times during the night to eat a fistful of Tums that barely helped.

So that was Day 1 as I remember it. My advice summed up: Have 2 people at the hospital with you. Warn the staff if you have anxiety; they can help you. Bring all post-op care stuff with you, including pain meds, ice, paper towels, trash bag, and maybe a diaper! ;) Take pain meds asap, ideally before your numbness wears off. Get Tums and an oral rinse or spray that moistens your mouth. Relax, have positive distractions, and keep track of your complicated care routine!

Day 2: Doctor follow-up and early recovery

18 Feb 2014

8 days post

Morning of Day 2 I was exhausted from getting basically no sleep the night before. Acid reflux, mouth dryness, pain, and having to pee so frequently kept me up. I showered, making sure to avoid getting water on my face. However, with the steam and heat I got super nauseous and ended up having to sit wet on the floor getting some cool air in order to balance out again. My Kotler Airway was very clogged, but I figured instead trying to clean it myself I'd just wait the couple hours until it was taken out. My pain level was still quite more than expected, and I was taking max pain medication.

I went to my follow-up appointment to get my packing and Airway removed. Since I had no functional work done, I only had to have packing for 1 day, woohoo! They gave me some numbing drips in my nose and pulled out the tubes first. It felt very weird since they were way in there, but not painful. Then came the packing. It was super gross and a scary and very unpleasant feeling, but again not really painful. They cleaned out my nose and it was awesome to breathe well again! Pro tip though: Even if you feel good that morning, take pain meds anyway because pulling all the stuff out will make it hurt a bit.

The rest of the day was hazy again. I liken it to a "brown-out" with alcohol: I don't recall much until someone brings up an event and then I start remembering it. Was still in pain and generally tired. I wan't thinking much about my emotions towards my face or how it looked because it was still in a cast and so swollen. Generally though, my profile looked pretty good, but the tip still looked very raised and I hoped it would fall a lot when the tape came off. My front looked bulbous and swollen and I wasn't going to worry about it too much yet, haha.

Day 5/6: Cast taken off and high emotions

18 Feb 2014

8 days post

This was an emotional day. I've been trying so hard not to focus on how my nose looks during this early stage because I know it will change a lot and I'm still swollen. I've heard the accounts from people that the emotional part of recovery is harder than the physical part, and despite how much pain I've been in, I think they were right. (Quick side note: Codeine gives you horrible constipation and I almost passed out from my first bowel movement. Good luck with that.)

Day 5 I went in to the doctor's again to get my cast off, and they had me evaluate myself in a 3-panel mirror. I'm embarrassed to say that as I was dreading, I broke down sobbing. I know I know I know it's still early, but it was just so jarring seeing a very different nose on my face in addition to the black eyes, swelling distorting my features, and general pain. I felt really bad because I do think my surgeon did a great job, it's more just that it's scary to see the change and it still looks different than what was predicted. Everyone in the office was so kind to me and reassuring, which I sincerely appreciated. For now I'm forcing myself to just detach and really try not to form an opinion for a while longer.

I felt sick and sad and didn't want to look at myself to take photos, but I attached one I took that day and others I took the very next day. I celebrated a low key Valentine's Day with my boyfriend who has been so sweet and positive about everything, so that was a great distraction.

Day 8/9: Continued recovery and trying to adjust

18 Feb 2014

8 days post

A few days have gone by and I'm finally caught up to real time, yay! The past few days have been... alright. I will say that general recovery is getting easier each day. I've gone full days without any pain meds, but I usually take one dose of Tylenol a day if it gets painful after cleaning. Some purples and greens persist under my eyes, but that's improving daily, too. My nose still feels tight and like clamped or something. The bridge especially hurts when touched, and the discomfort of my nose in general is on my mind 24/7.

As far as my emotions go, I'm feeling so-so with that, too. I'm getting more used to seeing my reflection, but I still generally dislike my nose from the front view. I also have extremely limited movement in my upper lip, so smiling is impossible. I feel like I look like a coy piggy lizard woman, haha. I'm not used to seeing so much of my nostrils since my nose used to droop. I look at old pictures of myself from the front, and my nose is actually more bulbous and wide now than before. I attribute that to swelling and have faith it'll settle down, but right now it makes me nervous. I see photos of other rhinoplasty patients and in under a week all their bruising and like 90% of their swelling is gone, and I get nervous for my seemingly slower progress. Patience, I guess.

My side and 3/4 views are already an improvement, but still not quite what I was expecting. The tip of my nose is still pretty high and puffy, kinda rounded and blunt. The side view of my predicted images looked so good to me, and I'm still holding out hope that my nose will change and get a little closer to that ideal even if not 100%.

My other concern is my nose's symmetry. I know I don't have a very symmetrical face, but my nose appears to point to the side a little even more noticeably than before. Similarly, one of my nostrils is way smaller than the other. I've heard that sometimes one side heals or de-swells faster than the other which can cause this, but I didn't expect the difference to be this extreme! Has anyone else experienced similar nostril asymmetry? (photo provided)

Just in general, I've been feeling kind of depressed. I'm currently very uneasy in my own skin, am still quite uncomfortable physically, and I feel like I'm held captive to this procedure just waiting with no predicted timeline or guarantee for when I'll feel like myself again. I want to be social, be productive, be able to laugh and smile, feel attractive around my boyfriend, be comfortable, and continue forward with my life again. I've always been uncomfortable with change and transitions, as well as stagnation interestingly, and somehow this experience is a miserable combination of both. I have the looming stress of needing to find a job soon, and the thought of confidently standing in front of potential employers in a high-pressure interview seems overwhelming when I can hardly look at myself in the mirror.

But I'm getting ahead of myself. For the time being, I'm starting with the small things... Wearing my regular make-up so I look more like myself and a little more attractive. Looking at old pictures to remind myself why I did this. Taking walks and going out in public a couple times each day. Making plans to see friends this week and catch up. Just trying to get engaged in my life again.

One cool piece of news I bet some of you can relate to: Today I was sitting with my boyfriend on the bed just chatting, and I realized we were in a position where he was looking directly at the side of my face. Upon noticing it, I automatically shifted so we could sit more face to face and he wouldn't be staring at my profile. I realized what I had done out of old habit and felt this moment of excitement and humor that I don't have to do that anymore because my nose is smaller and pretty now! Little things like that remind me why I felt the desire to make this change in the first place, and it gives me comfort that I'm not totally crazy for doing this! Wishing you all similar little victories :)

Day 13: Feeling much more positive; still healing though

4 Mar 2014

22 days post

I've been so busy with job-hunting preparation that I haven't been updating in real time, sorry! I'll write as if it were Days 9-13. Around the time of my previous post, I was definitely struggling with feelings of depression. The pain, unfamiliar looks, and disengagement with my normal life was taking a toll on me. This past week I pushed myself to be social and get some work done, and that combined with noticeable healing really lifted my attitude about this all. I still haven't completely gotten used to my new reflection, but my nose itself is looking a lot less puffy and the bruising under my eyes is almost gone. I'm no longer in pain, but still somewhat uncomfortable and it feels tight and stiff when I move my face too much. Very tolerable though.

Being the neurotic person I am, I started getting nervous about the amount of inner nasal swelling and nostril asymmetry I was experiencing. It looked like the area I'm assuming is the nasal valve was caving in, and I was fearing the possibility of a collapse. I emailed Dr. Kotler's administrator with a photo and a couple questions to clear my head. Within like an hour, Dr. Kotler personally wrote me this whole long message about how collapse won't happen that was thorough, reassuring, and humorous. I felt so much better and am really thankful that my surgeon and his staff give such high-quality care. I can't imagine going through this all without the continued support from them.

I'll include some more recent photos of what I look like now sans-makeup!

Days 21-23: Way happier with my looks and comfort overall

4 Mar 2014

22 days post

It's now been 3 weeks since my surgery! It feels so long ago that I was driving to Beverly Hills to get my face busted up, haha. Besides a nice new nose, I feel almost 100% back to normal. I'm chasing job leads, got some freelance work, and have seen a ton more people since my surgery. So far not a single person I've told had anything but a supportive response, and no one I've seen who wasn't informed about my surgery has commented on the change. To some that might be disappointing, but I'm actually relieved that generally people don't notice (or don't comment). I know myself that a huge change was made, so I just take it that my surgeon did a great job at making my nose look natural and suit me and that people aren't as critical of my looks as I am (surprise, surprise haha).

Happy to report that I can finally say my new nose feels more familiar than my former one. I was looking through old photos- which I haven't done in a while now- and my old nose looks so huge to me! It's taking some restraint to not untag myself from half my Facebook photos, hah... But yeah, I'm still anticipating further refinement, but generally I'm way happier with my current result.

Today I had a follow-up with Dr. Kotler. He, the staff, my family, and my boyfriend are all really pleased with the progress. Dr. K said my incision healing looks right on track and that I can expect further de-swelling. Although I do wish my nose was a liiiittle more pointed rather than round, overall I really have no complaints. My nose really fits my face and isn't overdone at all, and yet it's also enough of a change that the investment feels worth it and my self consciousness is alleviated. And as my nose continues to de-swell, a bit of sharper definition might show through and make me even more pleased with it.

Attached photos are from exactly 3 weeks in!

Day 29: 1 month post-op comparisons!

10 Mar 2014

28 days post

It's been exactly a month since my rhinoplasty! I'll post some comparison pics to commemorate. My inner nasal healing has progressed a lot in the past few weeks. The last of my visible stitches are gone and the incisions have scabbed over and come loose. My nasal swelling has gone down, although I feel somewhat congested higher up in my nose. My nose has been really itchy, probably from the scabbing and the nerves healing. Generally though, it's all very tolerable and I feel fine.

It's funny, this has been such a long process that I don't feel like I've had some kind of big unveiling moment. (Seeing myself with the cast off on Day 5 wasn't a happy experience, lol.) I look in the mirror and just kind of think, "Yup, there's my nose. It looks good, yeah..." When I have that anticlimactic reaction, I question whether going through this whole process and dropping $11k was worth it. But I guess it's evidence that a rhinoplasty or any other cosmetic surgery isn't going to "change your life" and be some magical thing. I'm still the same person in the same career in the same relationship in the same social group... Besides a few millimeters off my nose, nothing is really different. That seems obvious, but with all the build-up surrounding your plastic surgery, sometimes you forget. However, when I look back at old bad pictures of myself or feel one of those pulls out of habit to turn my face so somebody doesn't catch me at an unflattering angle, I remember that this decision was more about alieviating a self-consciousness rather than bringing something new into my life. So in that regard it was a success and will be worth it for the rest of my life, because I now feel much more comfortable with my looks. Just something to keep in mind for anyone out there considering cosmetic surgery themselves.

Day 29: More photos

10 Mar 2014

28 days post

I hate that you can't edit former posts! Here are the other 2 comparisons.